Caregivers and legal barriers: Navigating care of a family member diagnosed with cancer.

Abstract

11034 Background: Caregivers of patients with cancer are vital for coordinating care, but the extent to which they encounter social and legal barriers is unknown.We performed a nationwide analysis of a legal navigation program to assess caregiver utilization of services. Methods: This is a retrospective analysis of caregivers who used the Triage Cancer Legal & Financial Navigation Program for legal navigation services on behalf of a family member with cancer or for questions regarding caregiver responsibilities. Triage Cancer is a national nonprofit that provides free education on legal and practical issues impacting patients with cancer. We gathered demographic, financial, disease-site, and legal navigation data and implemented Poisson regression models to explore factors associated with each type of primary legal concern that prompted a call for assistance. Results: We examined calls from 553 caregivers between 2021-23 for family members with cancer who were 54% male, 44% aged 40-64y, 51% White, 26% employed, 32% on employer-sponsored insurance, and 42% with income <$50k. Most prevalent cancer types were hematologic (23%), CNS (14%), GI (10%), and breast (9%). A majority of caregivers sought assistance with 1 (51%) or 2 (35%) legal barriers. Most common primary issue was health insurance (34% - including issues related to insurance options, navigation, appeals), followed by financial (22% - financial assistance, housing), disability (15% - insurance applications, claim appeals), other (18% - estate planning, wills, advanced directives; life insurance; family law; education; COVID), and employment (10% - time off, working through treatment, returning to work, job loss, job search, unemployment benefits). Compared to reference groups, caregivers of Black patients (RR 2.2) were more likely to call for financial barriers, patients aged 40-64y (RR 3.4) for disability insurance, uninsured individuals (RR 5.6) for health insurance, and those with income between $50-100k (RR 3.1) or patient age 0-39 (RR 5.2) for employment-related difficulties. Conclusions: This study highlights the social and legal navigation undertaken by caregivers of patients with cancer. It underscores an urgent need for accessible legal navigation that considers the caregiver alongside the patient as one family unit undergoing care. [Table: see text]